提高经胸主动脉瓣球囊扩张术安全性的研究

Study on the safety improvement of transthoracic aortic balloon valvuloplasty

目的探讨新型动脉鞘管在经胸主动脉瓣球囊扩张术中的安全性。方法健康雄性小猪，自1月龄开始每日口服富含胆固醇（0．5％）的食物及维生素D2（100000IU／d），2个月后通过经胸超声测量主动脉瓣压差。选取16只主动脉瓣压差〉30mmHg（1mmHg=0．133kPa）的小猪，按中心随机方法随机分为A、B2组，每组8只，A组采用新型动脉鞘管，B组采用传统动脉鞘管。2组小猪经胸骨正中切口，经升主动脉插入动脉鞘管行主动脉瓣球囊扩张术。结果2组小猪均成功实施经胸主动脉瓣球囊扩张术。术前A组主动脉瓣压差为（41．3±3．9）mmHg，B组为（40．6±3．5）mmHg，2组比较差异无统计学意义（t=0．30，P=0．74）。术后2组小猪主动脉瓣压差均明显下降，分别为（12．5±1．6）mmHg和（12．8±1．9）mmHg，与术前比较差异均有统计学意义（t=23．83、23．79，P均〈0．001）。A组导丝通过主动脉瓣的时间明显短于B组，2组比较差异有统计学意义[（16．4±2．6）min比（27．4±4．6）min，t=5．88，P〈0．001]。A组误人冠状动脉的次数（1比10）及发生主动脉瓣和升主动脉损伤的例数（0比5）明显少于B组，2组比较差异有统计学意义（Z=-2．183、-2．219，P=0．029、0．027）。结论经胸主动脉瓣球囊扩张术是治疗主动脉瓣狭窄的有效方法。应用新型动脉鞘管行经胸主动脉瓣球囊扩张术较传统动脉鞘管更安全。

Objective To explore the security of using a new artery sheath in the transthoracic aortic balloon valvuloplasty. Methods Healthy male piglets began to take food orally,which was rich in cholesterin（0.5% ） and in Vitamin D2 （100 000 IU daily）. Sixteen of them were selected based on the aortic pressure gradient （ 〉 30 mmHg, 1 mmHg =0. 133 kPa） through transthoracic echocardiography and were randomly divided into 2 groups with 8 cases in each group. The piglets in group A adopted new artery sheath during operations, while the piglets in group B did the old one. Both groups underwent transthoracic aortic balloon valvuloplasty through the ascending aorta via sternotomy. Results The transthoracic aortic ballon valvuloplasty were carried out on all piglets successfully. There were no significant differences in the aortic valve pressure gradient before operation between group A and group B [ （41.3 ± 3.9 ） mmHg vs （40.6 ± 3.5 ） nanHg, t = 0.30, P = 0.74 ]. The aortic valve pressure gradient decreased distinctly to （ 12.5 ± 1.6） mmHg and（ 12.8 ± 1.9） mmHg, respectively after operation, and the differences were significant in statistics （t = 23.83,23.79 ,all P 〈0.001 ）. And the passage duration of the guide wire through aortic valve was significantly shorter in group A than that in group B [ （ 16.4 ± 2.6） min vs （27.4 ± 4.6） min, t = 5.88,P 〈 0.001 ]. The frequencies （ 1 to 10） of the guide wire strayed into coronary artery and the cases（0 to 5 ） of the aortic valve and ascending aorta injured by the guide wire in group A were significantly lower than those in group B, which had statistical significance （ Z = -2. 183, -2.219,P =0.029,0.027）. Conclusions Transthoracic aortic balloon valvuloplasty is an effective treatment for aortic stenosis. It＇s much safer to apply the new artery sheath than the old one in the operation.